We conducted a retrospective, single-center study to test our notion that laparoscopic transabdominal preperitoneal (TAPP) mesh repair of inguinal hernia is not inferior to open repair via anterior approach. Patient characteristics and short-term treatment outcomes were compared between 142 patients with 153 defects treated by TAPP repair between January 2010 and December 2015 and 100 patients with 104 defects treated by open anterior repair between September 2008 and December 2015. Patients in the TAPP group were significantly younger than patients in the open repair group. Operation time was significantly longer in the TAPP group at 102.8 minutes, but the blood loss volume did not differ significantly between the 2 groups. Conversion from TAPP repair to open repair was necessary for 6 patients, and this was because of adhesions found intraoperatively in all 6. Significantly fewer postoperative analgesics were used by patients in the TAPP group. Hydrocele occurred as a postoperative complication in both groups, and postoperative recurrence was observed in 2 patients in the TAPP group, but the complication rate did not differ significantly between the 2 groups. Although the TAPP procedure lengthened the repair time, the absence of a significant difference in postoperative complications confirms that TAPP repair compares favorably with open anterior repair.
The purpose of this study is to examine the effect of knee bracing on static and dynamic balance (postural stability). Two knee braces were examined: soft type (A, “Short Runner Airmesh”) and hard type (B, “Townsend-Rebel TM5”). For thirteen collegiate American football players, three conditions – no bracing (Group N), attached brace A (Group A), and attached brace B (Group B) – were set. All subjects performed three tests: a) single-leg standing with eyes closed to measure static balance, b) forward single-leg drop jump with eyes open, and c) lateral single-leg drop jump with eyes open to measure their dynamic balance, by using Zebris PDM-S system. We measured two items: 1. total track length (mm) of center of pressure (COP) and 2. confidence ellipse area (mm2). The results showed a significant difference between the groups in COP total track length of lateral single-leg drop jump with eyes open, with Group N: 539.2±74.4, Group A: 552.0±66.5, and Group B: 566.2±54.7 (mm). Consequently, dynamic balance was shown to decrease when a knee brace was worn, and a hard type reduced dynamic balance more than a soft type. We suspected that bilateral uprights contacted the knee joint hindered the joint proprioception, during controlling the balance of the side movement after landing. Moreover, many compression and contact parts against the knee joint due to the hard shell and rigid straps of a hard type caused to reduce the dynamic postural stability.
We previously reported a re-embedding catheter technique for peritoneal dialysis (PD) patients with high risk of catheter removal at the discontinuation of PD. We recently operated on a 50-year-old female patient who had resumed PD by externalization of the catheter after the re-embedding catheter technique. The patient had been on PD for acute kidney injury (AKI) due to a hypertensive emergency in 2009, but had discontinued PD after seven months because her creatinine levels decreased to 2 mg/dL. However, because her renal function did not normalize and she preferred to undergo PD for future renal replacement therapy, we applied the re-embedding catheter technique. She resumed PD by externalization of the catheter four years later. We consider the re-embedding catheter technique a useful method for AKI patients who do not recover normal renal function.
A 69-year-old man presented to us with a large peristomal bulge. He had undergone laparoscopic abdominoperineal resection with D3 dissection and sigmoid colostomy for lower rectal cancer and 14 months later began to notice a bulge in the stoma area. Because of an absence of specific symptoms, continued follow-up was decided upon. However, within 9 months, the bulge had grown so large that it had become difficult for the patient to secure the stoma bag in place, so surgery was performed. Abdominal computed tomography revealed the sigmoid colostomy as well as a hernial sac into which intra-abdominal fatty tissue had prolapsed. The sac was cranial to the lifted bowel. Laparoscopic repair was performed. Exploration of the abdominal cavity showed adherence of the greater omentum, sigmoid mesocolon, and fatty appendages to the abdominal wall around the lifted bowel. Upon adhesiolysis, a 3×3-cm hernial orifice cranial to the lifted sigmoid colon was seen. The orifice was closed with three sutures of 2–0 absorbable material and repaired with two different Parietex Parastomal meshes (keyhole style and central band style meshes). The two meshes were fixed so that they overlapped each other. Three cicatricial hernias observed along the midline of the lower abdomen were simultaneously repaired. The operation time was 170 minutes, and the blood loss volume was small. The postoperative course was uneventful. The patient began oral intake on postoperative day 1 and was discharged on postoperative day 4. One year and 6 months have passed since the surgery, and there is no evidence of recurrence. The laparoscopic two-mesh repair is described in detail along with a review of the literature.